Medicare HETS 270/271 Submitters:
CMS installed the HETS 270/271 R2017Q400 release on November 18, 2017. This significant release included the introduction of Qualified Medicare Beneficiary (QMB) data to the HETS 271 response. MCARE began distributing information about the R2017Q400 release to HETS 270/271 Submitters in August, 2017.
Following this HETS release, Medicare has received calls from Medicare Beneficiaries concerned about the accuracy of their Medicare data. The calls are related to erroneous hospital inpatient and Skilled Nursing Facility information being returned to providers and suppliers. We have verified Medicare records are accurate. It appears some EDI clearinghouses or vendors are misinterpreting the Medicare data and passing it on to Medicare providers and suppliers resulting in an impact on beneficiaries trying to receive services. Following the HETS R2017Q400 release, some EDI clearinghouses are incorrectly interpreting HETS 271 data (specifically QMB or non-QMB deductible and co-insurance periods) as inpatient spells in a hospital or Skilled Nursing Facility.
CMS reminds all HETS 270/271 Submitters that it is the responsibility of that Submitter to ensure that your organization is returning accurate and proper eligibility information to your Medicare Provider/Supplier users. Because of the impact this issue is having on beneficiaries, HETS Submitters returning incorrect data to their users need to communicate the issue to their users. Any Medicare Providers or Suppliers that contact CMS about the accuracy of Medicare data and we verify the Medicare records are accurate are being referred to their EDI clearinghouse or vendor.
As necessary, HETS 270/271 Submitters should again refer to the previously distributed R2017Q400 Release documentation to ensure that they are returning accurate Medicare eligibility data.
Release Summary: /Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/Downloads/R2017Q400HETS270271ReleaseSummary.pdf (PDF) (version 1.06)
Companion Guide: /Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/Downloads/HETS270271CompanionGuideUpcoming.pdf (PDF) (version 10-5)
Please contact the MCARE Help Desk if you have any questions or comments.